HIV success ratings are in the eye of the beholder

While the majority of Africans across 34 countries give low ratings to their governments’ job of providing such basic infrastructure needs as water, sanitation, and electricity, across the continent — from Swaziland to Cameroon, from Uganda to Nigeria — governments receive “an absolute majority” of high marks for their efforts to combat HIV and AIDS.

That’s the mixed news from the Afrobarometer research project’s recent cross-continent survey of What People Want from Government, Basic Survey Performance Ratings, 34 Countries, released in December. The report concludes that access to services as well as quality of services makes the difference in perceptions of whether governments are doing their jobs or not. Building a school, for example, is not enough to get high ratings on education efforts. Students have to be able to get to it, and then learn something while they are there, it seems.

This data came out right around the same time as this supplement from the Journal of the International AIDS Society called for urgent action to meet the needs of men who have sex with men, and challenged “the complacency and irrelevancy among donors and country governments that are uncomfortable in addressing key populations.” The conclusions in the supplement led AIDSpan’s Global Fund Observer to headline its article about it: “African HIV programming failing to respond to acute needs of sexual minorities.”

The supplement looks at institutionalized discrimination standing between men who have sex with men and HIV services and points to efforts to overcome that discrimination that, the introduction concludes are essential not only to reach targeted populations but for the sake of public health. It includes a look at the impact of a two-day training for health workers on the healthcare needs of men who have sex with men in Kenya, where 81 percent of those surveyed by Afrobarometer said the government was doing well fighting HIV, but where no such training has been available. With training, homophobic attitudes decreased markedly, leading authors of that study to conclude scaling up such training would make a meaningful impact on sexual health knowledge.

The supplement also includes a look at the fear caused by violence and lack of police protection for men who have sex with men in Swaziland, where the impact of HIV among those men remains largely underestimated and, where 92 percent of Afrobarometer’s respondents approve of their government’s HIV-fighting performance. the supplement includes research pointing to the role of community organizations providing health information for men who have sex with men in Cameroon, where 85 percent of those surveyed by Afrobarometer approved of their government’s HIV response. You get the idea. The IAS report reveals chasms in AIDS responses in Africa, but also offers evidence-based answers. It also answers a question raised by the first report: What is the value of services when they can’t be accessed, or have impact?